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Slekiene J, Chidziwisano K, Morse T. Does Poor Mental Health Impair the Effectiveness of Complementary Food Hygiene Behavior Change Intervention in Rural Malawi? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10589. [PMID: 36078302 PMCID: PMC9518201 DOI: 10.3390/ijerph191710589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Mental disorders have the potential to affect an individual's capacity to perform household daily activities such as water, sanitation, and hygiene (food hygiene inclusive) that require effort, time, and strong internal motivation. However, there is limited detailed assessment about the influence of mental health on food hygiene behaviors at household level. We conducted a follow-up study to detect the effects of mental health on food hygiene behaviors after food hygiene intervention delivery to child caregivers in rural Malawi. Face-to-face interviews, based on the Risk, Attitude, Norms, Ability, and Self-regulations (RANAS) model, were conducted with 819 participants (control and intervention group) to assess their handwashing and food hygiene-related behaviors. Mental health was assessed using the validated Self-Reporting Questionnaire. Study results showed a significant negative relationship between mental health and handwashing with soap behavior (r = -0.135) and keeping utensils in an elevated place (r = -0.093). Further, a significant difference was found between people with good versus poor mental health on handwashing with soap behavior (p = 0.050) among the intervention group. The results showed that the influence of the intervention on handwashing with soap behavior was mediated by mental health. Thus, integration of mental health in food hygiene interventions can result in improved outcomes for caregivers with poor mental health.
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Affiliation(s)
- Jurgita Slekiene
- Global Health Engineering (GHE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Clausiusstrasse 37, 8092 Zurich, Switzerland
| | - Kondwani Chidziwisano
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences (MUBAS), Private Bag 303, Chichiri, Blantyre 3, Malawi
- Department of Environmental Health, Malawi University of Business and Applied Sciences (MUBAS), Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Tracy Morse
- Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, Glasgow G1 1XQ, UK
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Mwapasa T, Chidziwisano K, Lally D, Morse T. Hygiene in early childhood development centres in low-income areas of Blantyre, Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022:1-17. [PMID: 35272551 DOI: 10.1080/09603123.2022.2048802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
Diarrhoeal disease remains a leading cause of death in children in sub-Saharan Africa, attributed to environmental health factors such as inadequate water, sanitation and hygiene (WASH) and food hygiene. This formative study in low-income areas of Blantyre focussed on the practices in Early Childhood Development Centre (ECDCs) environments where children spend a significant amount of time. A mixed-methods approach was applied to identify key hygiene behaviours in ECDCs through; checklist and structured observations (n = 849 children; n = 33 caregivers), focus group discussions (n = 25) and microbiological sampling (n = 261) of drinking water, food handler's hands, and eating utensils. ECDCs had inadequate WASH infrastructure; coupled with poor hygiene practices and unhygienic environments increased the risk of faecal-oral disease transmission. Presence of E. coli in drinking water confirmed observed poor water handling habits by staff and children. Addressing undesired hygiene practices in ECDCs has the potential to improve the health outcomes of children in low-income settings.
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Affiliation(s)
- Taonga Mwapasa
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi - The Polytechnic, Blantyre, Malawi
| | - Kondwani Chidziwisano
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi - The Polytechnic, Blantyre, Malawi
- Department of Environmental Health, University of Malawi - The Polytechnic, Blantyre, Malawi
| | - David Lally
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi - The Polytechnic, Blantyre, Malawi
| | - Tracy Morse
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi - The Polytechnic, Blantyre, Malawi
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
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Chidziwisano K, Slekiene J, Kumwenda S, Mosler HJ, Morse T. Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi. Am J Trop Med Hyg 2020; 101:294-303. [PMID: 31237230 PMCID: PMC6685574 DOI: 10.4269/ajtmh.18-0639] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of contextual and psychosocial factors for behavior change was conducted using Risk, Attitude, Norms, Ability, and Self-regulation model. We conducted 323 household surveys with caregivers of children aged 6 to 24 months. Analysis of variance was used to estimate difference between doers and non-doers of three targeted behaviors: washing utensils with soap, keeping utensils on a raised place, and handwashing with soap. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Perceived vulnerability determined effective handwashing and storage of utensils. Perceived social norms and ability estimates were favorable for the three targeted behaviors. Promotion of already existing targeted beneficial behaviors should be encouraged among caregivers. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers' technical know-how of local dish rack and tippy tap construction is essential.
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Affiliation(s)
- Kondwani Chidziwisano
- Department of Environmental Health and WASHTED Centre, Polytechnic, University of Malawi, Blantyre, Malawi.,Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, Scotland
| | - Jurgita Slekiene
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Save Kumwenda
- Department of Environmental Health and WASHTED Centre, Polytechnic, University of Malawi, Blantyre, Malawi
| | - Hans-Joachim Mosler
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Tracy Morse
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, Scotland.,Department of Environmental Health and WASHTED Centre, Polytechnic, University of Malawi, Blantyre, Malawi
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Anaemene B. Health and Diseases in Africa. THE DEVELOPMENT OF AFRICA 2018. [PMCID: PMC7122698 DOI: 10.1007/978-3-319-66242-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Parvez SM, Kwong L, Rahman MJ, Ercumen A, Pickering AJ, Ghosh PK, Rahman MZ, Das KK, Luby SP, Unicomb L. Escherichia coli contamination of child complementary foods and association with domestic hygiene in rural Bangladesh. Trop Med Int Health 2017; 22:547-557. [PMID: 28164415 DOI: 10.1111/tmi.12849] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the frequency and concentration of Escherichia coli in child complementary food and its association with domestic hygiene practices in rural Bangladesh. METHOD A total of 608 households with children <2 years were enrolled. We collected stored complementary food samples, performed spot checks on domestic hygiene and measured ambient temperature in the food storage area. Food samples were analysed using the IDEXX most probable number (MPN) method with Colilert-18 media to enumerate E. coli. We calculated adjusted prevalence ratios (APR) to assess the relationship between E. coli and domestic hygiene practices using modified Poisson regression, adjusting for clustering and confounders. RESULT Fifty-eight percentage of stored complementary food was contaminated with E. coli, and high levels of contamination (≥100 MPN/dry g food) were found in 12% of samples. High levels of food contamination were more prevalent in compounds where the food was stored uncovered (APR: 2.0, 95% CI: 1.2-3.2), transferred from the storage pot to the serving dish using hands (APR: 2.0, 95% CI: 1.3-3.2) or stored for >4 h (APR: 2.5, 95% CI: 1.5, 4.2), in compounds where water was unavailable in the food preparation area (APR: 2.6, 95% CI: 1.6, 4.2), where ≥1 fly was captured in the food preparation area (APR: 1.6, 95% CI: 1.0, 2.6), or where the ambient temperature was high (>25-40 °C) in the food storage area (APR: 2.7, 95% CI: 1.5, 4.4). CONCLUSION Interventions to keep stored food covered and ensure water availability in the food preparation area would be expected to reduce faecal contamination of complementary foods.
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Affiliation(s)
- Sarker Masud Parvez
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Musarrat Jabeen Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ayse Ercumen
- University of California Berkeley, Berkeley, CA, USA
| | | | - Probir K Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Zahidur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kishor Kumar Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Caregivers’ nutrition knowledge and attitudes are associated with household food diversity and children’s animal source food intake across different agro-ecological zones in Ghana. Br J Nutr 2015; 115:351-60. [DOI: 10.1017/s0007114515004468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractCaregivers’ nutrition knowledge and attitudes may influence the variety of foods available in the household and the quality of children’s diets. To test the link, this study collected data on caregivers’ (n 608) nutrition knowledge and feeding attitudes as well as the diets of their household and of their 2–5-year-old children in twelve rural communities nested in the three main agro-ecological zones of Ghana. Household foods and children’s animal source foods (ASF) consumed in the past 7 d were categorised into one of fourteen and ten groups, respectively. About 28 % of caregivers believed that their children needed to be fed only 2–3 times/d. Reasons for having adult supervision during child meal times, feeding diverse foods, prioritising a child to receive ASF and the perceived child benefits of ASF differed across zones (P<0·001). Households with caregivers belonging to the highest tertile of nutrition knowledge and attitude scores consumed more diverse diets compared with those of caregivers in the lowest tertile group (11·2 (sd 2·2) v. 10·0 (sd 2·4); P<0·001). After controlling for the effect of agro-ecological zone, caregivers’ nutrition knowledge and feeding attitudes positively predicted household dietary diversity and the frequency and diversity of children’s ASF intakes (P<0·001). The number of years of formal education of caregivers also positively predicted household dietary diversity and children’s ASF diversity (P<0·001). A key component to improving child nutrition is to understand the context-specific nutrition knowledge and feeding attitudes in order to identify relevant interventions.
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Islam MS, Mahmud ZH, Gope PS, Zaman RU, Hossain Z, Islam MS, Mondal D, Sharker MAY, Islam K, Jahan H, Bhuiya A, Endtz HP, Cravioto A, Curtis V, Touré O, Cairncross S. Hygiene intervention reduces contamination of weaning food in Bangladesh. Trop Med Int Health 2012; 18:250-8. [DOI: 10.1111/tmi.12051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mohammad Sirajul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Zahid Hayat Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Partha Sarathi Gope
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Rokon Uz Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Zakir Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Mohammad Shafiqul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | | | | | | | - Abbas Bhuiya
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Hubert P. Endtz
- Department of Medical Microbiology and Infectious Diseases; Erasmus MC; University Medical Centre; Rotterdam; The Netherlands
| | - Alejandro Cravioto
- International Centre for Diarrhoeal Disease Research, Bangladesh; Mohakhali; Dhaka; Bangladesh
| | - Valerie Curtis
- London School of Hygiene and Tropical Medicine; London; UK
| | - Ousmane Touré
- Agence Nationale de la Sécurité Sanitaire des Aliments; Ministère de la Santé; Bamako; Mali
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Burn prevention programs for children in developing countries require urgent attention: A targeted literature review. Burns 2010; 36:164-75. [DOI: 10.1016/j.burns.2009.06.215] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 06/15/2009] [Indexed: 11/19/2022]
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Rice J, Rice JS. The concentration of disadvantage and the rise of an urban penalty: urban slum prevalence and the social production of health inequalities in the developing countries. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2009; 39:749-70. [PMID: 19927413 DOI: 10.2190/hs.39.4.i] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Urban slums are proliferating in the developing countries. A corollary of this structural transformation is the increasing recognition of an urban penalty wherein slum populations exhibit notable inequalities in health relative to non-slum urban residents and even rural populations. The built urban environment, in turn, is a crucial context within which the social production of disproportionate morbidity and mortality is enacted. The authors develop this assertion and use bivariate and partial correlation analysis to highlight the association of urban slum prevalence, or proportion of the total population living in urban slum conditions, with indicators of mortality and gender parity, measured at the national level. Data for 99 developing countries show that greater urban slum prevalence is strongly correlated with higher levels of infant, child, and maternal mortality. Further, urban slum prevalence exhibits strong, deleterious correlations with gender parity (measured by the gender development index) and fertility rate, factors that have a crucial direct impact in shaping variant mortality levels. Future research is warranted on the social inequalities in health and illness derived from the expansion of urban slum conditions in the developing countries.
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Affiliation(s)
- James Rice
- Department of Sociology and Anthropology, New Mexico State University, Las Cruces 88003-8001, USA.
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Spontaneous fermentation of traditional sago starch in Papua New Guinea. Food Microbiol 2008; 26:136-41. [PMID: 19171254 DOI: 10.1016/j.fm.2008.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 10/07/2008] [Accepted: 10/09/2008] [Indexed: 11/23/2022]
Abstract
Sago starch is an important dietary carbohydrate in lowland Papua New Guinea (PNG). An investigation was conducted to determine whether microbes play a role in its preservation using traditional methods. In 12 stored sago samples collected from PNG villages, lactic acid bacteria (LAB) were present (> or = 3.6 x 10(4)cfu/g) and pH ranged from 6.8 to 4.2. Acetic and propionic acids were detected in all samples, while butyric, lactic and valeric acids were present in six or more. In freshly prepared sago, held in sealed containers in the laboratory at 30 degrees C, spontaneous fermentation by endogenous microflora of sago starch was observed. This was evident by increasing concentrations of acetic, butyric and lactic acids over 4 weeks, and pH reducing from 4.9 to 3.1: both LAB and yeasts were involved. Survival of potential bacterial pathogens was monitored by seeding sago starch with approximately 10(4)/g of selected organisms. Numbers of Bacillus cereus, Listeria monocytogenes and Staphylococcus aureus fell to < 30/g within 7 days. Salmonella sp. was present only in low numbers after 7 days (< 36/g), but Escherichia coli was still detectable after three weeks (> 10(2)/g). Fermentation appeared to increase the storability and safety of the product.
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Greenhill AR, Shipton WA, Omoloso AD, Amoa B, Warner JM. Bacterial contamination of sago starch in Papua New Guinea. J Food Prot 2007; 70:2868-72. [PMID: 18095446 DOI: 10.4315/0362-028x-70.12.2868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sago starch is an important food in lowland Papua New Guinea. Extraction of the starch from the palm and storage were performed by way of traditional methods that have been used for thousands of years. Currently, very little is known about the microbiology of sago starch. Sago samples were collected from areas of high starch utilization and analyzed for the presence of bacterial pathogens and indicator organisms. Storage methods and duration were recorded at the time of collection, and pH and water activity on arrival at the laboratory. Sago starch was found to harbor high levels of fecal contamination, as well as various food pathogens including Salmonella, Bacillus cereus, and coagulase-positive staphylococci. Clostridium perfringens was only present infrequently in samples and in very low numbers, while Listeria monocytogenes was not isolated from sago starch. The presence of high levels of fecal contamination in sago starch is of particular concern, and may contribute to diarrheal disease in rural Papua New Guinea.
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Affiliation(s)
- A R Greenhill
- School of Veterinary and Biomedical Sciences, James Cook University, Townsville, 4811 Queensland, Australia.
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Wamani H, Tylleskär T, Åstrøm AN, Tumwine JK, Peterson S. Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. Int J Equity Health 2004; 3:9. [PMID: 15482596 PMCID: PMC529301 DOI: 10.1186/1475-9276-3-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Accepted: 10/13/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Health and nutrition inequality is a result of a complex web of factors that include socio-economic inequalities. Various socio-economic indicators exist however some do not accurately predict inequalities in children. Others are not intervention feasible. OBJECTIVE: To examine the association of four socio-economic indicators namely: mothers' education, fathers' education, household asset index, and land ownership with growth stunting, which is used as a proxy for health and nutrition inequalities among infants and young children. METHODS: This was a cross-sectional survey conducted in the rural district of Hoima, Uganda. Two-stage cluster sampling design was used to obtain 720 child/mother pairs. Information on indicators of household socio-economic status and child anthropometry was gathered by administering a structured questionnaire to mothers in their home settings. Regression modelling was used to determine the association of socio-economic indicators with stunting. RESULTS: One hundred seventy two (25%) of the studied children were stunted, of which 105 (61%) were boys (p < 0.001). Bivariate analysis indicated a higher prevalence of stunting among children of: non-educated mothers compared to mothers educated above primary school (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.4-4.4); non-educated fathers compared to fathers educated above secondary school (OR 1.7, 95% CI 0.8-3.5); households belonging in the "poorest" quintile for the asset index compared to the "least poor" quintile (OR 2.1, 95% CI 1.2-3.7); Land ownership exhibited no differentials with stunting. Simultaneously adjusting all socio-economic indicators in conditional regression analysis left mothers' education as the only independent predictor of stunting with children of non-educated mothers significantly more likely to be stunted compared to those of mothers educated above primary school (OR 2.1, 95% CI 1.1-3.9). More boys than girls were significantly stunted in poorer than wealthier socio-economic strata. CONCLUSIONS: Of four socio-economic indicators, mothers' education is the best predictor for health and nutrition inequalities among infants and young children in rural Uganda. This suggests a need for appropriate formal education of the girl child aimed at promoting child health and nutrition. The finding that boys are adversely affected by poverty more than their female counterparts corroborates evidence from previous studies.
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Affiliation(s)
- Henry Wamani
- Centre for International Health, University of Bergen, Armauer Hansen Building, N-5021 Bergen, Norway
- Ministry of Health, P.O Box 7272, Kampala, Uganda
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, Armauer Hansen Building, N-5021 Bergen, Norway
| | - Anne Nordrehaug Åstrøm
- Centre for International Health, University of Bergen, Armauer Hansen Building, N-5021 Bergen, Norway
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University Medical School, P.O Box 7072, Kampala, Uganda
| | - Stefan Peterson
- Division of International Health (IHCAR), Karolinska Institute, Norrbacka, S-17176 Stockholm, Sweden
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Magnussen L, Ehiri J, Jolly P. Comprehensive Versus Selective Primary Health Care: Lessons For Global Health Policy. Health Aff (Millwood) 2004; 23:167-76. [PMID: 15160814 DOI: 10.1377/hlthaff.23.3.167] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary health care was declared the model for global health policy at a 1978 meeting of health ministers and experts from around the world. Primary health care requires a change in socioeconomic status, distribution of resources, a focus on health system development, and emphasis on basic health services. Considered too idealistic and expensive, it was replaced with a disease-focused, selective model. After several years of investment in vertical interventions, preventable diseases remain a major challenge for developing countries. The selective model has not responded adequately to the interrelationship between health and socioeconomic development, and a rethinking of global health policy is urgently needed.
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Affiliation(s)
- Lesley Magnussen
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
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International Influences on Public Health. PUBLIC HEALTH IN PRACTICE 2003. [DOI: 10.1007/978-0-230-21421-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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